LORETTA JOHNSON KENNEL PERMIT RENEWAL (K20-000066).PDF

Maricopa County
Animal Care And Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
El New /Renewal Permit # 2 0 - 0 00 OCD
Name: \--Ort,44, IStTh Kennel Name:Lo 'COW &:5(11SOYM 1r k,eiN eks
Mailing AddressaDSt V.tin (.9.5znat c4- 'Kennel Location: SC5Z) E Y.-e-a1/4-J0 Ca M.e-Wt "z
City fYV--661._ ZIP 35Q-63 County Supervisorial District e2 e
Home Phone: Z--M LtS7-2C-1-\S- Kennel Phone: t—t)o Lts-3 ocA
Please complete and si gn this application and return it to the above address with pa yment in the amount of
three hundred fifty dollars ($350.00) within ten ( 10) days of receipt.
Pursuant to Arizona statute and county ordinance, a person must obtain a kennel permit issued by the Board of
Supervisors if the person operates a kennel in which there are five or more do gs which are not individually
licensed. A.R.S. § 11-1009 (A). A kennel is defined as "an enclosed, controlled area, inaccessible to other
animals, in which .a ,person keeps, harbors or maintains five or more do gs under controlled conditions." A.R.S.
§ 11-1001 (8). _
An appointment will be scheduled for inspection of the kennel premises by an Animal Control Officer upon
receipt of this kennel permit application and fee. This kennel application properly executed and a copy of the
inspection report will then be forwarded to, and must be approved by, the Maricopa County Board of
Supervisors. The kennel perrrit form will be sent to you after approval and will be valid for one year from the
date of the Board's approval.
NOTE: Failure to show fora scheduled inspection and/or failure of inspection will warrant a Subsequent
Inspection Return fee of $49 fc - each additional visit. Failure of inspection may result in denial of the kennel
permit and require individual licensing of each dog under the provisions of A.R.S. S11-1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
1. %b/d I/We assume compete responsibility for the kennel at the premises for which I/we are makin g
applicati.n for a permit and unjerstand that "kennel" means an enclosed, controlled area, inaccessible to other
animals, in which a person keeps, harbors or maintains five or more do gs under controlled conditions (ARS 11-
100
iii I il/VVe certify that I/We have Co dogs and that the kennel meets the definition in statute.
3. 4 9 /VVe certify that I/VVe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
or 13-2 ' (dog fighting) , or similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leash laws DO NOT apply) .
4. ull\l/VVe certify that all dc gs over the age of three (3) months that are kept, harbored or maintained on the
preriiseelof the above named I.ennel have been properl y vaccinated against rabies by a veterinarian licensed to

practice in the state of Arizona and that a current vaccination certificate signed by a licensed veterinarian is
maintained on the premises for aach dog.
51414 I /We certify that I/INe are submitting a valid copy of the rabies vaccination certificate for each
dog ler this application.
6. gl/We understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S'. M11-1008. I/we also understand that a dog leaving the controlled kennel conditions shall be licensed
under A.R.S. § 11-1008 except if the dog is only being transported to another kennel which has a permit issued
under this section.
7. fig I/We understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
pe lty of twenty-five dollars in i'ddition to the annual fee.
I/We understand that a person who knowingly fails to obtain a kennel permit within thirty days after
otification from the cou:!ty enforcement agent is guilty of a class 2 misdemeanor..
9.LLU The undersigned unde:stand that that the kennel permit does not authorize the operation of any type
of b-usiliess and is solely used )r the purpose of licensing multiple dogs.
I/We certify that all of the information I/We have provided is true and accurate under penalty of law.
Applicant Signature
Applicant Signature
For Official Use Only:
Copies of Valid Rabies Vaccination Certificates for each dog attached
Copy of Person's Valid Identificati )n Attached
Type of Identification submitted
BOS Approval Date Term of Permit
2 of 2

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
http://pets.maricopa.Q0V
Receipt Number: R19-889506 Receipt Date: 09/03/2019
Person ID: P2704970
Phone: 480 4530015
LORETTA JOHNSON KENNELS
503 E KENWOOD ST 9/3/2019 1:04:20PM
MESA, AZ 85203
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K20-000066 $350.00 1 $350.00
Total Fees Due: $350.00
Payments: Cash:
Check: $350.00
Credit Card:
Total Payments Received: $350.00
Thank You!
Would you like to share your experience with our service to you? Change: $0.00
Please visit our website at http://pets.maricopa.gov and click on Balance Due: $0.00
"Contact Us" to email your comments for our review.
Animal Information:
A7777777 KENNEL PERM - BORN 9/14/1999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
johnsonk WBUS OFF

Maricopa County
Animal Care & Control
2500 South 27th Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT K20-000066
PREMISE INSPECTION
Number of Dogs: 6
Name: LORETTA JOHNSON Kennel Name: LORETTA JOHNSON KENNELS
Mailing Address: 503 E Kenwood St Kennel Address: SAME AS MAIL
City: MESA State: AZ Zip: 85203 County Supervisorial District: 4
Phone: 480-453-0015 Kennel Phone: 480-453-0015
1. Are all dogs over the age of three months properly vaccinated for rabies and in
possession of a valid rabies vaccination certificate?
YES
2. Is the kennel an enclosed, controlled area, inaccessible to other animals, in which a
person keeps, harbors or maintains five or more dogs under controlled conditions?
YES
NOTE: Copies of each rabies vaccination certificate must be attached to the Kennel Permit
Premise Inspection form.
CORRECTIVE ACTION NEEDED FOR COMPLIANCE AND N/A DAYS GIVEN
BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the
Inspector by check upon each return visit.)
There are 6 dogs on the kennel premises; all dogs have current rabies vaccinations and all
are confined to the kennel property under controlled conditions.
This is a RENEWAL and there have been no complaints regarding this address.
Deputy Enforcement Agent & Badge #: Lt. Romero #4 Date: 913119
October 2015

Loretta Johnson
503 E Kenwood St pf5 jr Bonfield Rabies Certificate
Mesa, AZ 85203 —vs PET HOSPITAL
Home Phone: (480) 453-0015 Certificate Date
loretta_johnson1974@yahoo.com Banfield Pet Hospital
1863 N Stapley Dr, Ste 104 Monday, August 26, 2019 6:26 PM
Mesa, AZ 85203-5203
(480) 969-7331
Pet Information
Rabies Tags
Name: Lilly Johnson
Species: Canine
Ban field
Breed: Chihuahua National Pet ID#
Gender: Female 4260725
Color: Tan County & Tag #
Age: 2y/Om None
Weight: 9.20 lbs
Microchip ID: Manufacturer:
Microchip ID: Manufacturer:
Vaccine Information
Vaccine Name : Rabies (Type: Killed)
Producer: Zoetis Defensor 3
Administered: 8/26/2019 Route: Subcutaneous Site: Right Rear
Due Date: 8/26/2020
Lot/Serial #: 343374B
Lot/Serial Expires: 9/22/2020
I hereby certify that I have vaccinated this pet in accordance with all state and Federal laws and
regulations on this date.
Administered by:
Licel ised 17 etdf-inarian: Dr. Chantel Garino
DVM\L: ense Number: 7400
Any rabies certificate for this pet printed prior to the date of this certificate is null and void
ReportID: RabiesCert.en.x Hospital #5198 Page loll
Time Printed: 6:26 PM Date Printed: 8/26/2019

VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $: Name
ADAPTED NASPHV FORM 51 Tag #: LI RABIES
PRINT — use ballpoint pen or type Cert. Serial #:
Owner's Name & Address LYME DISEASE
P-PiPg LIST FIR E TELEPHONE 0 CANINE DISTEMPER
riA--k. LI A) LID 0005" 0 CANINE PARAINFLUENZA
NO. STREET CITY STATE ZIP CANINE ADENOVIRUS 2
'. V\ Q-0 WCIOEI,'- 1/— MeçC,C, 42, STd-O3 CANINE PARVOVIRUS
SPECIES: SEX: AGE: I SIZE: ThiDOMINANT BREED: cF,ORS: 0 CANINE CORONAVIRUS
Dog )Zr Male 0 Months 1 1:3 Under 20 lbs. ID L-Ackl CI CANINE BORDETELLA
Cat Ci Female 5?t, 20-50 lbs. U LEPTOSPIROSIS
Years Y
Other ID Altered 0 Over 50 lbs. ,Si NAME: CI FELINE LEUKEMIA VIRUS
ma (
(Specify) FELINE PANLEUKOPENIA
atik_
0 FELINE RHINOTRACHEITIS
DATE VACCINATED: PRODUCER: 9 o e Veterinarian's # SOID
FELINE CALICIVIRUS
(C':) lal (First 3 Letters) License No.
FELINE CHLAMYDOPHILA
Month Day Year PRODUCT NAME:. Veteri aarian's Na pl se t)
b ve„c_
VACCINATION EXPIRES: 1 yr. LicNacc. id
Signature
'.\(') 3 yr. LicNacc. U
Address 1\f( 0
Month Day Year
VacC. Serial (Lot) No.
USCAHNON02066
I VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $: Name
ADAPTED NASPHV FORM 51 Tag #: I 0 RABIES
PRINT — use ballpoint pen or type Cert. Serial #:
Owner's Name & Address 01 LYME DISEASE
P.-RtN,T LAST FIRST D MI TELEPHONE ---- Li CANINE DISTEMPER
_) Or\ ir\S-1) ,*\ 1 iva—k_ k-- q-gt)ub bp° CANINE PARAINFLUENZA
NO. STREET CITY STATE ZIP LI CANINE ADENOV1RUS 2
k LUC\ W1)0A Me5 CL— A-4' Th 3 LI CANINE PARVOVIRUS
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS: U CANINE CORONAVIRUS
Dog 7.--,4-- - Male _ Li n Months c• U Under 20 lbs. U r k LI CANINE BORDETELLA
Cat ID Female -g' 20-50 lbs. 0 ....-1 - 0 LEPTOSPIROSIS
Other 0 Altered U Years 1— 0 Over 50 lbs. >I NAME:
U FELINE LEUKEMIA VIRUS
(Specify) —1 e_ \Q LI FELINE PANLEUKOPENIA
DATE VACCINATED: PRODUCER: IJ FELINE RHINOTRACHEITIS
-e Veterinarian's #
FELINE CALICIVIRUS
( -\°2 [CI (First 3 Letters) License No.
Ci FELINE CHLAMYDOPHILA
Month Day Year A
P9DI4CT NAME Name (please print)
KGA-4,66-` 4, la
VACCINATION EXPIRES: 1 yr. LicNacc. i AN
Signature I me&
K) 3 yr. LicNacc. 0 I my
czac.X.A .1 - Address
Month Day Year
Vacc. Serial (Lot) No. 4rAP
USCAHNON02066

VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $: Name
ADAPTED NASPHV FORM 51 Tag #: _ 0 RABIES
Owner's Name & Address PRINT — use ballpoint pen or type Cert. Serial #: 0 LYME DISEASE
—
P-T--LAIT, . FIST MI (TIL EI.„.4 EP7L? Dm 0 CANINE DISTEMPER
-tc) L 0 CANINE PARAINFLUENZA
NO SIRE CITY STATE ZIP sl2c) 0 CANINE ADENOVIRUS 2
...c.„,
5b J• • / 0 CANINE PARVOVIRUS
SPECIES: SEX: AGE: ti SIZE: • : EDOMINNT BREED: COL e EkS: ID CANINE CORONAVIRUS
Dog Male 0 Months 0 u Under 20 lbs. u rife U CANINE BORDETELLA
Cat 10 Female 20-50 Ibs. , ' /lb Fir ; k LEPTOSPIROSIS
Other 17 Altered El Years Over 50 lbs. U NAME:
0 FELINE LEUKEMIA VIRUS
(Specify)
tvL U FELINE PANLEUKOPENIA
DATE VACCINATED: PRODUCER: '-.367 ,-., U FELINE RHINOTRACHEITIS
k., Veterinarian's #
R' ID FELINE CALICIVIRUS
),9 n (First 3 Letters) License No. U FELINE CHLAMYDOPHILA
Month Day Year
PAODUCT NAME: Veterikarian's Name (please prin
i 1.0410 C
VACCINATION EXPIRES: EXPIRES: 1 yr. LicNacc. Et/
Signature
),.C.) 3 yr. LicNacc. i7A.
Address ,
Month Day Year
Vacc: Serial (Lot) No.
USCAHNON02066
VACCINATION RECORD
RABIES VACCINATION CERTIFICATE Tag fee $: Name
ADAPTED NASPHV FORM 51 Tag #: 0 RABIES
Owner's Name & Address PRINT — use ballpoint pen or type Cert. Serial #:
U LYME DISEASE
PD 3INT6LAv7n,sliv FIRST rLe4& L MI TELEPHONE, 0 CANINE DISTEMPER
yp (713 X /X 0 CANINE PARAINFLUENZA
STREET CITY STATE ZIP CANINE ADENOVIRUS 2
L76) _F VW 0 9thxl -fr N-19--ccL_ —7,----- Oi CANINE PARVOVIRUS
SPECIES SEX: AGE: SIZE: y EDOMI ANT BREED: C • ORS: 0 CANINE CORONAVIRUS
Dog Male Months —2— 1:1 Under 20 lbs. 0 I 4, I • ..._41—. U CANINE BORDETELLA
Cat 0 Female 0 20-50 lbs. 0 LEPTOSPIROSIS
Other U Altered Years Over 50 lbs. RE:
0 FELINE LEUKEMIA VIRUS
(Specify
) FELINE PANLEUKOPENIA
DATE VACCINATED: PRODUCER: --{; 0 - -e, r 0 FELINE RHINOTRACHEITIS
Veterinarian's #
as [el FELINE CALICIVIRUS
(First 3 Letters) License No.
FELINE CHLAMYDOPHILA
Month Day Year
DU T NAME: V-ter. Narian 's Name (please mil
C---2- 0
VACCINATION EXPIRES: 1 yr. LicNacc. ki •
Signature
3 yr. LicNacc. c=I
R)P&G/ 7A- Address
Month Day Year -
Vacc. Serial (Lot) No. 469 2)76
USCAHNON02066

Month K Month DATE (Specify) Other Cat Dog SPECIES: -Ne- Owner's
USCAHNON02066 VACCINATION U 0 )it PTV-
Day (k Day i\.S VACCINATED: Name
Altered Female Male SEX: ST &
Year (16 EXPIRES: Year ICI EET Address
U )2(--- U i(e,0
yr. 3 yr. 1 Years Months AGE:
PRODUCER: (JOD
LicNacc. LicNacc. FIT_ED
PRgt(,,JCRAZs tr 0 v/ Ca RABIES
Vacc. U LIC (First b..2 u 17 -Sili PRINT ADAPTED
Serial 7eia002 3 C) ,..., rejk
Letters) ,,, Over 20-50 Under SIZE: CITY — use
(Lot) 50 lbs. 20 Old4 VACCINATION
No. e.i lbs. lbs. ballpoint NASPHV
r 0 0 pen
A or FORM
Address Signature VAer NAME: , type CERTIFICATE
Veterinarian's PREDOMINANT 4? MI 51
V rci's 0.2y STATE
#
Name BREED:
CA-CO License pf.
(please No. ea COLS zIP TEl Cert. Tag Tag
3-F) print) IP ea9, : - Serial #: fee $:
(CL- 1 S.;-(-23 (6 #:
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